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Meningoencephalocele adalah defek kongenital yang sangat jarang, tapi insidennya tinggi di Asia Tenggara, termasuk di Indonesia. Penderita dengan nasofrontal meningoencephalocele memerlukan koreksi pembedahan sedini mungkin karena adanya kelainan bentuk wajah, gangguan pandangan, bertambahnya ukuran meningoencephalocele disebabkan bertambahnya prolaps cerebri dan risiko infeksi. Dalam laporan ini kami presentasikan kasus seorang bayi 9 bulan dengan meningoencephalocele naso-orbital dan hydrocephalus non communican yang menjalani operasi VP shunt dan eksisi cele. Adanya massa tersebut, baik meningoencephalocele nasofrontal atau frontoethmoidal maupun occipital, menimbulkan kesulitan bagi ahli anestesi mulai saat induksi, pemeliharaan anestesi dan pasca operasinya. Menjadi tantangan bagi ahli anestesi dalam pengelolaan meningoencephalocele, dimana sebagian besar penderitanya adalah anak-anak yang mempunyai kesulitan tersendiri, termasuk mengamankan jalan nafas dengan intubasi dan adanya massa yang akan mempersulit ventilasi saat induksi, adanya massa pada nasofrontal serta nasoethmoidal yang berhubungan dengan komplikasinya dan penilaian yang tepat terhadap perdarahan dan hipotermia.Anesthesia Management for A child with Nasofrontal Meningoencephalocele and Hydrocephalus Non CommunicantMeningoencephaloceles are very rare congenital malformations in the world that have a high incidence in the population of Southeast Asia, include in Indonesia. Children with nasofrontal meningoencephaloceles should have surgical correction as early as possible because of the facial dysmorphia, impairment of binocular vision, increasing size of the meningoencephalocele caused by increasing brain prolapse, and risk of infection of the central nervous system. In this report, we presented a case of a 9 months-old baby girl with nasofrontal meningoencephalocele and hydrocephalus non communican, posted for VP shunt (ventriculo-peritoneal shunt) and cele excision. Because of the mass, nasofrontal or frontoethmoidal and occipital meningoencephalocele leads the anaesthetist to problems since the preoperative visit, time of induction, maintenance of anaesthesia during the operation until post operative care. Anaesthetic challenges in management of meningoencephalocele, which most of the patients are children, include ventilation, intubation and securing the airway with intubation with the mass in nasofrontal and nasoethmoidal with its associated complications and accurate assessment of bloodloss and prevention of hypothermia.

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The induction and maintenance of anaesthesia with ether using a combined intravenous infusion and a constant low inspired concentration are discribed. Predictions from a mathematical model were checked against animal experiments. Anaesthesia occurred within 5 min. The mehtod obviates the need for explosive mixtures.